Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure

Gerard Linssen, Emilie Klaver, Mathilde Hermans, Alexandra Kleberger, Elly Rodijk, Selah Saïd, Lisette van Gemert-Pijnen

Research output: Contribution to conferenceAbstractAcademic

Abstract

Background: Optimized application of telemonitoring may enhance specialized medical care of patients with heart failure (HF). Our objective was to study methods to minimise the amount of alarms generated by the telemonitoring system, without losing clinically important information.

Methods: We included in a pilot project, 25 clinically stable patients with chronic HF. The data were obtained through the iMediSense™ telemonitoring system (2016, Thales, Hengelo, the Netherlands), clinically supervised by cardiologists and nurse practitioners (NPs). The patients were instructed to conduct measurements at least once daily for 60 days: diastolic blood pressure (dBP), systolic blood pressure (sBP), heart rate (HR) and body weight, also they filled out a HF-symptoms-questionnaire. When measurements exceeded predefined ranges, alarms were generated. NPs were instructed to view the generated alarms and react accordingly. We carried out simulations of different alarm systems: (weight-based) rule of thumb, moving average convergence divergence (MACD) and moving average (MA). The primary outcome of our study was the adjustment of HF medication.

Findings: Based on the symptoms questionnaires, only few adjustments of medication were carried out (n=10). A total of 865 responses were given by NPs to the 1471 generated alarms. The most common response yielded wait-and-see (47%, n=406). The response of the NPs was undocumented by the iMediSense™ system in 45% of the cases (n=391). The interview with NPs revealed that the NP will only respond to when a trend is visible. Both sBP and HR driven alarms were able to detect true positives (TPs). MA simulation driven by both parameters gave the highest amount of TPs, 0.6% (n=9) and lowest amount of FPs, 33.5% (n=293).

Discussion: In stable heart failure patients we found that a moving average algorithm based on systolic blood pressure and heart rate, improved accuracy of alarms generated by the telemonitoring system, in comparison to preset thresholds.
Original languageEnglish
Publication statusPublished - 1 Jun 2018
EventSupporting Health by Technology VIII 2018 - University of Twente, Enschede, Netherlands
Duration: 1 Jun 20181 Jun 2018
Conference number: 8
http://healthbytech.com/

Conference

ConferenceSupporting Health by Technology VIII 2018
CountryNetherlands
CityEnschede
Period1/06/181/06/18
Internet address

Fingerprint

Nurse Practitioners
Heart Failure
Blood Pressure
Technology
Heart Rate
Netherlands
Patient Care
Body Weight
Outcome Assessment (Health Care)
Interviews
Weights and Measures

Cite this

Linssen, G., Klaver, E., Hermans, M., Kleberger, A., Rodijk, E., Saïd, S., & van Gemert-Pijnen, L. (2018). Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure. Abstract from Supporting Health by Technology VIII 2018, Enschede, Netherlands.
Linssen, Gerard ; Klaver, Emilie ; Hermans, Mathilde ; Kleberger, Alexandra ; Rodijk, Elly ; Saïd, Selah ; van Gemert-Pijnen, Lisette. / Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure. Abstract from Supporting Health by Technology VIII 2018, Enschede, Netherlands.
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Linssen, G, Klaver, E, Hermans, M, Kleberger, A, Rodijk, E, Saïd, S & van Gemert-Pijnen, L 2018, 'Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure' Supporting Health by Technology VIII 2018, Enschede, Netherlands, 1/06/18 - 1/06/18, .

Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure. / Linssen, Gerard; Klaver, Emilie; Hermans, Mathilde; Kleberger, Alexandra; Rodijk, Elly; Saïd, Selah; van Gemert-Pijnen, Lisette.

2018. Abstract from Supporting Health by Technology VIII 2018, Enschede, Netherlands.

Research output: Contribution to conferenceAbstractAcademic

TY - CONF

T1 - Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure

AU - Linssen, Gerard

AU - Klaver, Emilie

AU - Hermans, Mathilde

AU - Kleberger, Alexandra

AU - Rodijk, Elly

AU - Saïd, Selah

AU - van Gemert-Pijnen, Lisette

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Optimized application of telemonitoring may enhance specialized medical care of patients with heart failure (HF). Our objective was to study methods to minimise the amount of alarms generated by the telemonitoring system, without losing clinically important information.Methods: We included in a pilot project, 25 clinically stable patients with chronic HF. The data were obtained through the iMediSense™ telemonitoring system (2016, Thales, Hengelo, the Netherlands), clinically supervised by cardiologists and nurse practitioners (NPs). The patients were instructed to conduct measurements at least once daily for 60 days: diastolic blood pressure (dBP), systolic blood pressure (sBP), heart rate (HR) and body weight, also they filled out a HF-symptoms-questionnaire. When measurements exceeded predefined ranges, alarms were generated. NPs were instructed to view the generated alarms and react accordingly. We carried out simulations of different alarm systems: (weight-based) rule of thumb, moving average convergence divergence (MACD) and moving average (MA). The primary outcome of our study was the adjustment of HF medication.Findings: Based on the symptoms questionnaires, only few adjustments of medication were carried out (n=10). A total of 865 responses were given by NPs to the 1471 generated alarms. The most common response yielded wait-and-see (47%, n=406). The response of the NPs was undocumented by the iMediSense™ system in 45% of the cases (n=391). The interview with NPs revealed that the NP will only respond to when a trend is visible. Both sBP and HR driven alarms were able to detect true positives (TPs). MA simulation driven by both parameters gave the highest amount of TPs, 0.6% (n=9) and lowest amount of FPs, 33.5% (n=293).Discussion: In stable heart failure patients we found that a moving average algorithm based on systolic blood pressure and heart rate, improved accuracy of alarms generated by the telemonitoring system, in comparison to preset thresholds.

AB - Background: Optimized application of telemonitoring may enhance specialized medical care of patients with heart failure (HF). Our objective was to study methods to minimise the amount of alarms generated by the telemonitoring system, without losing clinically important information.Methods: We included in a pilot project, 25 clinically stable patients with chronic HF. The data were obtained through the iMediSense™ telemonitoring system (2016, Thales, Hengelo, the Netherlands), clinically supervised by cardiologists and nurse practitioners (NPs). The patients were instructed to conduct measurements at least once daily for 60 days: diastolic blood pressure (dBP), systolic blood pressure (sBP), heart rate (HR) and body weight, also they filled out a HF-symptoms-questionnaire. When measurements exceeded predefined ranges, alarms were generated. NPs were instructed to view the generated alarms and react accordingly. We carried out simulations of different alarm systems: (weight-based) rule of thumb, moving average convergence divergence (MACD) and moving average (MA). The primary outcome of our study was the adjustment of HF medication.Findings: Based on the symptoms questionnaires, only few adjustments of medication were carried out (n=10). A total of 865 responses were given by NPs to the 1471 generated alarms. The most common response yielded wait-and-see (47%, n=406). The response of the NPs was undocumented by the iMediSense™ system in 45% of the cases (n=391). The interview with NPs revealed that the NP will only respond to when a trend is visible. Both sBP and HR driven alarms were able to detect true positives (TPs). MA simulation driven by both parameters gave the highest amount of TPs, 0.6% (n=9) and lowest amount of FPs, 33.5% (n=293).Discussion: In stable heart failure patients we found that a moving average algorithm based on systolic blood pressure and heart rate, improved accuracy of alarms generated by the telemonitoring system, in comparison to preset thresholds.

M3 - Abstract

ER -

Linssen G, Klaver E, Hermans M, Kleberger A, Rodijk E, Saïd S et al. Reducing clinically irrelevant alarms generated by a new telemonitoring technology in patients with heart failure. 2018. Abstract from Supporting Health by Technology VIII 2018, Enschede, Netherlands.